Chronic rhinosinusitis is a common chronic inflammatory condition of sinonasal cavities and occurs with or without nasal polyps. Uncontrolled chronic rhinosinusitis with nasal polyp (CRSwNP) has a negative impact on an individual’s quality of life. Many studies have been conducted for novel treatments targeting type 2 cytokines involved in CRSwNP such as interleukin (IL)-4, IL-5, IL-13 and immunoglobulin E. Biologics have recently been proven to improve the nasal symptoms of CRSwNP and reduce the need for systemic glucocorticosteroids. Recently dupilumab, omalizumab and mepolizumab were approved by Food and Drug Administration for CRSwNP, and other biologics are under investigation. Large-scale and longterm clinical trials are needed for therapeutic effectiveness, and several questions remain regarding patient selection, treatment algorithm, and cost-effectiveness. Nevertheless, emerging biologics may offer a new therapeutic option for uncontrolled CRSwNP.
Local allergic rhinitis (LAR) is a localized nasal allergic response in the absence of systemic atopy. The symptoms, duration, severity, and comorbidities of LAR are similar to those of allergic rhinitis. Although pathophysiology of LAR is not fully understood, in some patients specific IgE can be demonstrated in the nasal secretions. The diagnosis currently relies on the positive results of nasal provocation test. Nasal provocation test has shown high sensitivity and specificity with safety, and is considered as the gold standard. LAR patients benefit from the same therapeutic strategies as allergic rhinitis patients, including the avoidance of allergen exposure and the pharmacotherapy. Effectiveness and safety of allergen immunotherapy open a window of treatment opportunity in LAR. This review provides a current update on LAR.
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